A descriptive survey of healthcare professionals on traditional, complementary and alternative medicine integration in hospitals in Gauteng

Abstract

Background: Traditional, complementary, and alternative medicine (TCAM) use varies globally. The World Health Organisation (WHO) has estimated that 80% of the African population relies on TCAM as their first healthcare source. There is thus a high estimated prevalence of TCAM use in South Africa and studies showing potential for serious interactions between TCAM and conventional medicines. A common example of a fatal interactive profile has been demonstrated between a natural product, St. John’s Wort (Hypericum perforatum) and conventional antidepressants. Furthermore, garlic, gingko, and echinacea, are natural products that interact with conventional medicines since they can inhibit or induce cytochrome P450 liver enzymes. Medical history-taking is a vital process in the provision of healthcare, often assisting in identifying potentially such unwanted side effects or interactions. Aim: To determine the knowledge, attitudes, perceptions, and practices (KAP) of authorised prescribing and dispensing HCPs on TCAM use among the patient population, in three public, academic hospitals in Gauteng. Methods: A self-administered, cross-sectional survey was carried out among prescribing and dispensing HCPs working at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Helen Joseph Hospital in Auckland and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). All analyses were performed using STATA version 14 (StataCorp, USA) and statistical significance was determined at the 5% level of significance. A t-test analysis, chi-square test, Spearman rank correlation, and a multiple linear regression model were used to analyse the data. Results: A total of 233 prescribing and dispensing HCPs participated in the study surpassing the initially intended sample size of 226. However, upon analysis, only 188 responses met the inclusion criteria, of which the majority of the participants were between 18 and 30 (112, 58.9%) years of age with most respondents being females (112, 58.9%). The study identified HCP's poor knowledge (69.0%) of TCAM but positive attitudes (90.0%) towards TCAM. Most participants (104, 55.3%) in this study reported that they were aware of the prevalence of TCAM use but 98 (51.1%) participants stated that they were unaware of the potential interactions between TCAM and conventional vii medicines. Participants showed a positive attitude towards TCAM incorporation in the medical curriculum and believed that TCAM incorporation into the health system would enhance patient care. With respect to practice, a few (80, 43.0%) HCPs would enquire about TCAM use during history-taking. The Spearman rank correlation revealed significant positive linear correlations between knowledge-attitudes (p < 0.05), knowledge-practices (p < 0.05), and attitudes-practices (p < 0.05). Conclusion: Healthcare professionals have sub-optimal knowledge (69.0%) of TCAM and a positive attitude (90.0%) towards TCAM. There is a need for interventions to make sure that HCPs have the knowledge and tools they need to encourage the inclusion of TCAM in history- taking procedures and within the health system. Guideline recommendations are based on scientific data; therefore, there is a need for evidence- based research on TCAM. A more equitable level of healthcare can be achieved by combining several healthcare systems that now coexist in the same space.